Postpartum depression has become a catch all phrase for the mood disorders that some women experience after delivery or when a pregnancy ends. While research and clinical practice indicate the enormous variation of symptom presentation across many diagnostic categories, the stereotype of postpartum depression persists – the scarlet letter of the 21st century.
In the media, in news stories and among whispered tales in communities across America, the mother with postpartum depression is often depicted as an out of control, non functioning and seriously ill woman who cannot be trusted with her child.
Recently, much has been written about the media’s role in characterizing the extremely rare condition of postpartum psychosis as interchangeable with postpartum depression. We have lamented this clinically and medically erroneous sensationalism as adding to stigma and possibly preventing women from reaching out for fear of social judgment and condemnation. Just last week, ABC’s Private Practice website featured a damning poll questioning whether the psychotic mother depicted on the show had the right to even see her child. How could this possibly encourage a suffering mother to raise her hand? The prospect of hospitalization, steady decline into madness and potential loss of one’s child would hardly evoke self-identification even among women who desperately need immediate and strong intervention.
But there is another group of mothers disserviced by these regretful misrepresentations. And those are the women who may indeed have a pregnancy related mood disorder but think that because their symptoms do not equal the extreme drama portrayed in such stories, that they do not have postpartum depression. That their suffering is not sufficient to warrant intervention, help and compassion. These are the mothers who know that something is wrong, but compare themselves to these extremely rare depictions and think they are just “blue” and attempt to tough it out – week after hellish week.
“Thank God that’s not me” such a mother might think while making such comparisons, even as her own nights are sleepless, her heart empty and the person and dreams she once knew have disappeared. “I couldn’t have postpartum depression”, she thinks, “because I am able to get up and work and take care of my baby”. Never mind she is a shadow of her former self, she assumes the joylessness of her relationships, even that with her child, are her own fault. She concludes that she has failed, that motherhood has found her lacking, that she is unworthy of compassion and assistance. "After all" she thinks," women who are really ill with postpartum depression are in bed aren’t they? Or in the hospital, or running away from their families, hearing voices and thinking of ending it all?"
She does wonder how this emptiness came to be and if it will ever end as she plows through each isolating day, crying to herself and hiding the extent of her disability from those she loves and even from herself. This mother does not think she has postpartum depression because she is functioning.
These mothers can suffer for months, blaming themselves and feeling unworthy of help because they do not know that postpartum depression, postpartum anxiety, postpartum OCD and other diagnostic variations can manifest in many ways - allowing a mother to function but separating her from herself and her soul and causing intense mental suffering. She is but a ghost of her former self - but if she is going to work, doing the grocery shopping and going through the motions of caring for her child, she feels she merits no special notice.
Clinically, we associate major depressive disorder with lethargy, exhaustion, poor or increased appetite, hypersomnia or insomnia and intense feelings of guilt and hopelessness. And these symptoms may indeed be present and indicate the need for rapid intervention. But often in the postpartum period, the depression is agitated masking the feelings of despair with activity and hyper vigilance, causing mothers and loved ones to doubt that depression is present. Such activity and pseudo competence may give the illusion of health, obscuring the suffering that deadens each day as guilt increases with self-blame. Family and friends look at the busyness, the meals on the table and the lack of tears and think, “she’s fine, maybe a little tired, but fine”. So she drives harder herself to meet these expectations.
If you, or a pregnant or new mother you know seems agitated or unlike herself, even though the dishes are done and the baby is thriving, please approach gently and ask her how she is? Every week family members and friends ask me what they can do to help? Offer to listen, offer to help, let her know you have noticed, that it is NOT supposed to be this hard, that every expression of depression is different. Give her books to read, websites to visit and numbers to call of support groups and professionals. And most of all, lend your ear and heart without judgment…as this is often the turning point which leads to treatment seeking and eventual recovery.